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Examining the subtle and complicated relationship between living organisms and electromagnetic fields.
By Tiziano Marovino, DPT, MPH, DAAPM

The topic of electromagnetism can be both confusing and controversial, yet I find it intriguing and fascinating. The history of electromagnetic field (EMF) application and research has been mired in secrecy and suspicion, none more so than early government-sponsored projects whose activities were never clearly described. Before we begin to construct a working model for EMF usage in medicine and health, we will review some important fundamental terms and parameters.

A magnetic field (MF) is a magnetic force that extends out from a magnet and can be either static or dynamic. These MFs are produced by electric currents and specifically as a result of electron movement in 1 (DC) or 2 (AC) directions. In AC current, the electricity is moving back and forth and, as a result, produces a dynamic magnetic field. The greater the current, the greater the magnetic field. An EMF by definition refers to a dynamic or fluctuating MF and contains both an electric and a magnetic field. A specification that often is referenced is the rate or frequency of electromagnetic energy, which refers to the number of fluctuations and is expressed in hertz or cycles per second. Another important parameter used to describe or characterize an EMF is the wavelength, and because EMFs are typically conceptualized as waves with peaks and troughs, the wavelength is the distance between crests of a wave.

A DC current has a zero frequency in contrast to gamma and cosmic rays, which by comparison, have a very high frequency. All EMFs are capable of traveling through space at a great distance and can exert effects from afar. These fields carry energy and can be described either in terms of particles (photons) or waves, demonstrating characteristics of both. It is important to note that photons are packets of energy that can vary in terms of the amount of energy they carry. The energy level of a photon is related to the frequency it carries, with higher frequency photons having higher energy levels. The Figure depicts how the electromagnetic spectrum and visible light forms a small portion of the total spectrum.

Medical Biophysics

Another important distinction we should make is that of endogenous fields (produced in the body) versus exogenous fields (produced outside of the body). These exogenous fields can be further subdivided into natural fields (earths geomagnetic field) versus artificial or man-made fields, such as transformers, electricity lines, medical devices, appliances, and radio transmitters. In medical biophysics, an ionizing EMF (gamma or x-rays) refers to radiation energy strong enough to disrupt the cell nucleus and dislodge electrons from a molecule.

Ionization has been described in a continuum of strength from very strong to very weak. High-energy (high frequency) gamma and x-rays have high ionizing potential, whereas visible light radiation has weak ionizing capabilities. Various types of radiation exposure are of concern, including acute (short duration) exposure to high-energy fields, which have been extensively studied. However, just as or possibly more important are the more prolonged (longer duration) exposures to non- or weak ionizing radiation found in common household, work, and recreational applications. Prolonged exposure to what is generally considered or classified as, nonionizing radiation in the low frequency range (300-10,000 Hz), to extremely low frequency (ELF; 1-300 Hz) range, is an important question that we will consider.
Paradoxical Responses

Although it has been known that prolonged exposures to strongly ionizing EMFs can cause significant damage in biological tissues, recent epidemiologic studies have implicated long-term exposures to low-frequency, oscillating, nonionizing, exogenous EMFs—such as those emitted by power lines—as having health hazards. At the same time, there have been discoveries through research that also suggest that ELF radiation can have therapeutic healing effects in tissue.

Similar to the “specificity” seen in drugs (in that, a certain drug will target a set of receptors leading to a therapeutic effect), so too can electromagnetic radiation be configured in such a manner that leads to a specific effect(s). The configuration process has had a logical starting point, that is, observe what endogenous tissue electrical currents presently look like. When we examine biological currents, such as nerve/muscle activity, cardiac discharge, and brain electrical activity using electromyography, electrocardiography, or electroencephalography, respectively, one cannot help but speculate as to the nature of the intelligence being carried by the weak EMFs being created.

The exploration of this phenomenon could have great diagnostic and therapeutic value. It has been proposed that alterations in the endogenous EMF of cells and tissue may lead to disease, with restoration of correct EMFs leading to tissue healing. Physical corrections aside, there is a growing body of evidence suggesting that psychological “auto correction” is possible, meaning that we are capable of self-regulating and correcting our individual electromagnetic profile.

Furthermore, because all living matter emits some level of radiation via our endogenous EMFs, this might help explain the positive effects of many forms of therapies from positive imagery and biofeedback to acupuncture and polarity work. For those readers who have a difficult time understanding or appreciating the possibility of paradoxical responses, that is, how electromagnetic radiation can be both very good and/or very bad for us, we use a pharmacotherapy analogy for clarification. It is difficult to imagine a historically more therapeutically important drug than penicillin in terms of the number of lives it has saved and the morbidity spared by its use. Even so, 15% to 20% of the population is allergic to it, and a small but significant proportion of these people will have an anaphylactic reaction to the drug, placing them at risk for hospitalization and even death. Despite this unusual sensitivity to the drug, it continues to be an important medication with well-defined benefits.

In the same manner, a similar phenomenon exists regarding electric or electromagnetic radiation. There are probably susceptible individuals in the population who react adversely to electromagnetic radiation within certain frequency ranges based on their unique endogenous electromagnetic profile. This susceptibility factor will be discussed in a later section. An example of the paradoxical effect might be the case of melatonin, which is secreted by the pineal gland and thought to regulate biorhythms. Melatonin is known to be oncostatic, stopping certain cancer growth. Low levels of pulsed electro-magnetic field (PEMF) application has been demonstrated to suppress melatonin, thus suppressing an anti-cancer effect and interrupting circadian functions such as sleep. A natural area for study would be to identify how altering the electromagnetic dosage or configuration might stimulate melatonin production, thereby ameliorating sleep dysfunction or the jet lag experience.1
Applications of Bio-electromagnetics

There is a further distinction amongst bio-electromagnetic (BEM) devices—whether they are thermal or non-thermal. Certain modalities produce heat in tissues and others do not. Biologic nonthermal means that a modality does not cause significant gross tissue heating. Physically nonthermal refers to being below the thermal noise limit at physiologic temperatures.2 The energy level at thermal noise is much lower than that required to cause heating of tissue, so any physically nonthermal application is automatically biologically nonthermal. Some traditional applications that use electromagnetic radiation include the entire family of therapies known as electrophysical agents. These are discussed in more detail later in this section but generally are used with the purpose of reducing pain, muscle spasms, inflammation, and/or improving superficial/deep circulation status and subsequent healing potential.

It is important to note that electro-magnetic energy often is used to assess or aid in the diagnostic process when used in electromyography, biofeedback, electroencephalography, electro-retinography, and in imaging tests such as magnetic resonance, positron emission tomography, computed tomography (CT), ultrasound, and radiography applications. Energy dosages vary with all these applications with some being ionizing radiation (x-ray/CT).

Electrophysical Agents

There are several new areas of EMF application, including bone repair, wound healing, nerve stimulation, tissue regeneration, osteoarthritis therapy, and electroacupuncture. The healing of non-union bone fractures using various types of electromagnetic energy including low-level electric currents (micro-currents) have become popular. Ultrasonic (radio waves) also have been used for bone healing with similar results. Finally, PEMFs have become popular in Canada, Europe, and Asia, less so in the United States, but their use is growing as well.

Efficacy of electromagnetic bone repair treatment has been confirmed in double-blind trials.3,4 The FDA has approved the use of PEMFs for bone repair purposes. In Canada, the use of PEMF is very common in rehabilitation in both hospital-based and outpatient sectors. PEMFs are used for the treatment of osteoarthritis, migraine headaches, and in complex regional pain syndromes or sympathetically maintained pain states (formerly known as RSD). Their widespread use has not been associated with significant side effects, and they are generally considered mainstream and therapeutic.

Of interest is that it was empirical (observational) evidence gathered by practicing physical therapists (PTs) when applying PEMFs on patients who had both long-bone fractures with concomitant soft tissue trauma that alerted orthopedic surgeons of the possible accelerated healing properties of this form of radiation, which led to eventual application in bone healing. Similar empirical reports from PTs in the field spurred the development of micro-current technology and low- level laser therapy to eventually find a place in orthopedics and cosmetic surgery, respectively. There was basic science evidence at both the in vitro and in vivo level for all these forms of electromagnetic energy prior to clinical applications, but it wasn’t until many years after the empirical evidence mounted, that funding became available to conduct more sophisticated validation studies that confirmed PTs’ observations.

In any case, the use of EMFs for recalcitrant bone fracture repair represents a step toward acceptance and understanding of the importance this form of energy represents in the healing process and life in general. The collective work of Athenstaedt,5 Burr,6 and Becker7 have all acted to shed light on the potentially important role that electricity plays in the organization and functioning of living things. The work of Funk et al8 has better elucidated the relationship between ion transporters and ion channels to the electric action of cells and tissues. Ion concentrations act as triggers with concomitant electric gradients being traced along signaling cascades until gene expression is changed in the nucleus. The idea that all living tissue is in motion, resonating in alternating fields (ELF EMF), is fundamental to the biologic electromagnetic paradigm.
Electromedicine

There is a bewildering array of electro-medical devices in the marketplace today—many of those being used in physical therapy/medicine. What sets them apart from each other are the parameter specifications typically expressed in electrotherapy language as waveform (asymmetrical biphasic, symmetrical biphasic, etc), frequency, phase-pulse and burst duration, polarity, and amplitude. These terms describe the essential characteristics of electrotherapy devices used in medicine today. Devices such as transcutaneous electrical neuromuscular stimulation (TENS), interferential current (IFC), direct current (DC), micro-current (MENS), high-voltage stimulation, and electric muscle stimulation (EMS) have their own unique electromagnetic signature but are generally non-thermal within the normal range of patient intensity values.

Other forms of electromagnetic spectral energy include the various forms of light energy used in lasers and sound energy used in ultrasonic applications. The use of both light and sound waves in medicine is broad in application and these energy forms can be either thermal or non-thermal, depending on the power/intensity specifications, with depth of penetration being determined primarily by wavelength in phototherapy and frequency in electrotherapy. Other forms of thermal energy in medicine include shortwave diathermy, microwave, and hydrotherapy. Other non-thermal applications include percutaneous electrical stimulation (PENS), iontophoresis, radiofrequency (RF), infra-red and ultraviolet therapies.

It is thought that nonthermal exogenous EMFs have the potential to exert significant biologic effects in living organisms. These effects can either be harmful or beneficial, depending on exposure parameters and susceptibility factors (bio-sensitivity). The cell membrane is perhaps the most likely site of transduction (energy conversion) of EMF bio-effects. Investigators have proposed changes in cell membrane binding and transport mechanisms and/or displacement or deformation of polarized molecules. The biophysical effects by which EMFs might act on bio-molecules are far too complex for this report. However, work by Liboff might be helpful for those inclined to further study this phenomenon 9-11 Biohazards of EMFs.

There have been many reports in the past linking chronic exposure to EMFs with various types of morbidities, including various cancers and more recently diabetes. Claims of excessive microwave exposures (cell phones) causing brain tumors have been explored and findings continue to be debated.

There is evidence that brain function can be altered with chronic exposure to 900 MHz radiation produced artificially by a generator using rats as the subjects under study.12 These particular authors attempted to reproduce average human exposure levels encountered in daily life from all sources, but this was difficult since radiation levels will vary from person to person. Electro-pollution, or dirty electricity as it is sometimes referred to, is ubiquitous and difficult to measure completely from all its sources. For this reason, an accurate risk assessment is challenging at this time and helps explain the controversial findings that exist in the literature today.

There are many opinions espoused from just as many government agencies and special interest groups, including the World Health Organization whose task force on the subject concluded that there is not enough evidence to implicate EMF in childhood leukemia, which was, and is, perhaps the most suspected pathology linked to EMF.13

The Canadian government seems to agree and has said it sees no clear link between common electromagnetic exposure levels and any morbidity.13 Nevertheless, some research does in fact link EMF exposures to a number of health effects, including neurodegenerative disorders (amyotrophic lateral sclerosis), leukemia, miscarriage, and clinical depression. Several studies have found significant increases in relative risk for conditions, such as leukemia, as a result of EMF exposures from such sources as radio transmitters and electric transmission lines.14-16 In the United Kingdom, a perhaps more prudent solution stemming from a more cautious interpretation of the literature to date has led to a construction policy that prohibits new residential buildings from being erected within 60 meters of existing power lines.

A recent study by Havas et al found that EMFs were implicated in elevating blood sugar levels in patients with diabetes and in those with prediabetes.17 He found that by manipulating the EMF levels in the environment (dirty electricity) he could control plasma glucose levels. He went on to explain that this might be the reason why patients with brittle diabetes have such a hard time regulating blood sugar levels.

Furthermore, he estimates that as many as 5 to 60 million diabetics worldwide may be affected by high levels of EMF radiation. Havas refers to EMF-susceptible hyperglycemic individuals as type 3 diabetics. Unlike those with type 1 and 2 diabetes whose disease is caused by a lack of insulin or resistance to insulin, respectively, the type 3 diabetic patient has elevated glucose as a result of environmental triggers.17
Conclusion

The interaction between living organisms and electro-magnetic fields appears to be both subtle and complicated, with current research only having scratched the surface of this topic. The future will bring better and greater research efforts and hopefully uncover the mysterious and little understood relationship between EMF and life. The early discoveries by Robert Becker that injury and healing each have their own current characteristics, and later, Pohl observing an electric field in living cells in culture do lend credence to the possibility that living organisms have electrically mediated organization.18

We now know that bone exhibits a piezo-electric effect through its electromechanical properties such that weight bearing forces act to signal to the undifferentiated cells in bone whether to become osteoblasts or osteoclasts—consistent with Wolff’s law of bone remodeling. Our observation in astronauts (nongravity-induced osteopenia) is consistent with these findings.

It is interesting to note that the piezo-electric property of bone has been attributed to the collagenous network inherent within bone. If this observation is accurate, the implications would be significant because collagen is fundamental to organs and soft tissue, especially the myofascial system.19 Again, for those so inclined, a visual masterpiece in the form of a DVD entitled “Strolling Under the Skin” was created by surgeon Jean-Claude Guimberteau, MD, and will not disappoint those interested in further discovering the architecture of subdermal collagenous structures. Using high-powered microscopy his work will take you on a journey never seen before, one that supports the connection between electromagnetic energy and the living organism.

QPT is a hybrid facility offering many diagnostic and treatment options for our patients. We do not subscribe to any one type of approach or system of treatment techniques, believing rather that each individual patient will respond differently to different types of therapy. Both research and experience support this premise. The axiom that “when all you have is a hammer—everything looks like a nail” is one that health care consumers might consider when choosing a health care provider. Our staff is selected on experience and proficiency in patient interaction, skill in judgment, and problem solving abilities, rather than on familiarity with a specific approach. Our expectation is that QPT staff embrace the concept of evidence based practice and develop a skill set that is consistent with a more global expertise versus the more restrictive uni-dimensional (guru) approach. We are proud to be able to offer our patients a wide variety of treatment approaches with therapeutic exercise being the foundation for most of our treatments.

Much has been written about back pain with therapy exercise. In addition there is other written information on neck pain and exercise. QPT is also a research center and has currently published material available for interested patients and referral sources. Our mission statement encompasses not only the treatment performance aspects of our centers, but also that they be centers of excellence for teaching and research. To this end, we are active in education by giving talks and seminars at national conferences but also workshops in ultrasonographic imaging and auriculo-therapy through our educational arm.

Author’s Bio: Tiziano Marovino, DPT, MPH, DAAPM, is Vice President of Health Strategy and Innovation for Biogenesis Group—a total population health management company specializing in corporate wellness. He also is Clinical Operations Manager for Quantum Physical Therapy Centers in Washtenaw County, MI. Dr. Marovino is an outside clinical instructor in the athletic training program at the University of Michigan. His research interests are in outcome design, measurement, and evaluation.